Extensive research of the long-term outcomes of premature infants has shown significant risk for emotional, behavioral, and psychological problems. Chronic stress and trauma have not been researched specifically in this population, however, studies of the neurobiological impact of traumatic stress on infants and children in the general population show noteworthy parallels in symptomotology. Careful consideration should be given to practitioner caregiving, parent education, future research, assessment, and interventions while being mindful of the impact that chronic stress and trauma may have on the developing brain of the premature infant.
This is a preview of subscription content, access via your institution
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Get just this article for as long as you need it
Prices may be subject to local taxes which are calculated during checkout
March of Dimes. Maternal, Infant, and Child Health in the United States: March of Dimes Data Book for Policy Makers. New York: March of Dimes; 2003.
Tracy AE, Maroney DI . Your Premature Baby and Child. New York: Berkley Publishing; 1999.
Botting N, Powls A, Cooke R, Marlow N . Attention deficit hyperactivity disorder and other psychiatric outcomes in very low birthweight children at 12 years. J Child Psychol Psychiatry 1997;38:931–941.
Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ . Cognitive and behavioral outcomes of school-ages children who were born preterm: a meta-analysis. J Am Med Assoc 2002;288(6):728–737.
Merriam-Webster's Collegiate Dictionary. 10th ed. Springfield, MA: Merriam-Webster, Inc.; 1993.
Van der Kolk BA . The psychobiology of posttraumatic stress disorder. J Clin Psychiatry 1997;58 (Suppl 9):16–24.
Perry BD, Pollard R . A neurodevelopmental view of childhood trauma. Child Adoles Psychiatr Clin North Am 1998;7(1):33–51.
Barker D, Rutter N . Exposure to invasive procedures in NICU admissions. Arch Dis Children: Fetal Neonatal Educ 1995;72:F47.
Bhutta AT, Anand KJ . Vulnerability of the developing brain. Neuronal mechanisms. Clin Perinatol 2002;29(3):357–372.
Perry BD, Pollard RA, Blakley TL, Baker WL, Vigilante D . Childhood trauma, the neurobiology of adaptation, and “use-dependent” development of the brain: how “states” become “traits”. Infant Mental Health J 1995;16(4):271–289.
Teicher MH, Andersen SL, Polcari A, Anderson CM, Navalta CP . Developmental neurobiology of childhood stress and trauma. Psychiatric Clin North Am 2002;25(2):397–426.
Schore AN . Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder. Austral New Zealand J Psychiatry 2002;36(1):9–30.
Streeck-Fischer A, van der Kolk BA . Down will come baby, cradle and all: diagnostic and therapeutic implications of chronic trauma on child development. Austral New Zealand J Psychiatry 2000;34(6):903–918.
Low JA, Froese AB, Smith JT . Hypotension and hypoxaemia in the preterm newborn during the four days following delivery identify infants at risk of echosonographically demonstrate cerebral lesions. Clin Invest Med 1992;15(1):60–65.
Whitfield MF, Grunau RE . Behavior, pain perception, and the extremely low-birth weight survivor. Clin Perinatol 2000;27(2): 363–379.
Perlman JM . Neurobehavioral deficits in premature graduates of intensive care—potential medical and neonatal environmental risk factors. Pediatrics 2001;108(6):1339–1348.
Call JD, Galenson E, Tyson RL, editors. Frontiers in Infant Psychiatry. New York: Basic Books, Inc.; 1983.
Van der Kolk BA, McFarlane AC, Weisaeth L . Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York: The Gilford Press; 1996.
Perry BD, Azad I . Posttraumatic stress disorders in children and adolescents. Curr Opin Pediatrics 1999;11:310–318.
Wintgens A, Boileau B, Robaey P . Posttraumatic stress symptoms and medical procedures in children. Canad J Psychiatry 1997;42(6):611–616.
Delaney-Black V, Covington C, Ondersma SJ, Nordstrom-Klee B, Templin R, Ager J, Janisse J, Sokol RJ . Violence exposure, trauma, and IQ and/or reading deficits among urban children. Arch Pediatric Adolesc Med 2002;56(3):280–285.
Whitfield, Grunau, Holsti . Extremely premature schoolchildren (=⩽ 800 grams): Mulitiple areas of hidden disability. Arch Dis Childhood 1997;77:F85-90.
Brandt P, Magyary D, Hammond M, Barnard K . Learning and behavioral-emotional problems of children born preterm at second grade. J Pediatr Psychol 1992;17(3):292–311.
Saigal S, Hoult LA, Streiner DL, Stoskopf BL, Rosenbaum PL . School difficulties at adolescence in a regional cohort of children who were extremely low birth weight. Pediatrics 2000;105(2):325–331.
Aaron J, Zaglul H, Emery RE . Posttraumatic stress in children following acute physical injury. J Pediatr Psychol 1999;24(4):335–343.
DeMier RL, Hynan MT, Harris HB, Manniello RL . Perinatal stressors as predictors of symptoms of posttraumatic stress in mothers of infants at high risk. J Perinatol 1996;16(4):276–280.
Manne S, DuHamel K, Redd WH . Association of psychological vulnerability factors to post-traumatic stress symptomatology in mothers of pediatric cancer survivors. Psychooncology 2000;9(5):372–384.
Mitchell A, Brooks S, Roane D . The premature infant and painful procedures. Pain Manage Nurs 2002;1(2):58–65.
Symington A, Pinelli J . Developmental care for promoting development and preventing morbidity in preterm infants (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford: Update Software; 2003.
Miller TW . Children of Trauma: Stressful Life Events on Children and Adolescents. Madison, CT: International Universities Press, Inc.; 1998.
Feldman R, Eidelman AI, Sirota L, Weller A . Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm infant development. Pediatrics 2002;110(1 Part 1):16–26.
Vickers A, Ohlsson A, Lacy JB, Horsley A . Massage for promoting growth and development of preterm and/or low birth-weight infants. Cochrane Database Systems Rev 2002;(2):CD000390.
Mathai S, Fernandez A, Mondkar J, Kanbur W . Effects of tachtile-kinesthetic stimulation in preterms: a controlled trial. Indian Pediatrics 2001;38(10):1091–1098.
Lindrea KB, Stainton MC . A case study of infant massage outcomes. Am J Maternal Child Nurs 2000;25(2):95–99.
Davis DL, Stein MT . The Emotional Journey of Parenting Your Premature Baby: A Book of Hope and Healing, Golden, CO: Fulcrum Publishing, in press.
Rights and permissions
About this article
Cite this article
Maroney, D. Recognizing the Potential Effect of Stress and Trauma on Premature Infants in the NICU: How are Outcomes Affected?. J Perinatol 23, 679–683 (2003). https://doi.org/10.1038/sj.jp.7211010
This article is cited by
Effectiviteit van video-interactiebegeleiding in het ziekenhuis voor ouder-kind interactie, hechting en stress bij ouders na vroeggeboorte: een gerandomiseerde gecontroleerde trial
Gezinstherapie Wereldwijd (2017)
Grande prématurité : que faire des pères dans une unité de néonatalogie ?
Revue de médecine périnatale (2017)
Pain score assessment in babies undergoing laser treatment for retinopathy of prematurity under sub-tenon anaesthesia
The development of potentially better practices to support the neurodevelopment of infants in the NICU
Journal of Perinatology (2007)